Tag Archives: obama

I never realized I was such a slacker next to President Bush. I was sent an article comparing the reading habits of Presidents Obama and Bush. Bush, it appears, had an ongoing competition with Karl Rove to see who could read the most and reportedly read nearly 2 per week (95 in 2006) during parts of his presidency. In April, Obama stated he is reading Joseph O’Neill’s novel “Netherland” and repeated it in a recent BBC interview, putting him at a pace of only 10 books per year.

While this isn’t a very accurate measurement of Obama’s commitment to reading–and I think we’d all rather him be leading our country!–I realized that I’m not doing much better. So, I committed to reading 1 book per week over the next year. I’m using my Book Log to help me track myprogress. Anyone else up for the challenge?

The American Recovery & Reinvestment Act of 2009–the Stimulus Package–apportions $19 billion for investment into the HIT infrastructure in the US. As much as $3 billion goes to the Office of the National Coordinator (which will now be codified) and other standards creating bodies. The remaining amount will be given to providers primarily through increased Medicare reimbursement. If divided evenly, each hospital would receive approximately $11 million. A substantial sum, but hardly close to the $200 million over 3 years required in a typical implementation at a 300+ bed hospital. Only 10% of hospitals currently have full electronic health records. Another 20-30% are in planning or implementation stages. The stimulus may encourage more providers to enter the planning stages and will help along those already in the process during difficult economic times. But $11 million for the remaining 60-70% is entirely insufficient.

Evidence shows that the only providers that stand to get a return on investment in HIT are large network providers with geographically distributed practices, such as Kaiser or the VA. This makes sense, as the administrative cost of sharing information is high. The early adopters (the 10%) consist of these large networks and a few providers with well-funded, forward-thinking CIOs. The 20-30% currently planning hope to break even at best and justify the investment by improved patient care (especially through CPOE). The rest are mostly too small to realize significant cost savings and will likely need much more than $11 million to break even.

The compromise stimulus deal leaves much of each chamber’s proposed funding for health information technology intact, according to an overview circulated by House Speaker Pelosi Wednesday and a preliminary summary of the compromise that was subject to change. The final package provides $19 billion to encourage nationwide adoption of electronic medical records, with $17 billion for Medicare and Medicaid incentives for federally qualified health centers, rural health clinics, children’s hospitals, and others. The Senate version, which won approval Tuesday after members stripped out $100 billion, included $16 billion for Medicare and Medicaid incentives, about $2 billion less than the House plan that passed last month. The Senate also imposed a $1.5 billion cap on incentive payments to “critical access hospitals,” while the House included no such language. Conferees reportedly accounted for those facilities, but it is unclear whether the cap remained.

The negotiated stimulus would provide temporary bonuses of as much as $64,000 for physicians and up to $11 million for hospitals that adopt e-health records, the summary document stated. Medicare penalties for noncompliance would also be phased in starting in 2014. The package would also codify the HHS Office of the National Coordinator for Health IT and establish a transparent process for developing standards for e-health records by 2010. An immediate $2 billion would be available to HHS for health IT infrastructure, training, telemedicine, and other grants. The Senate had previously asked for $3 billion, while the House wanted just over $2 billion.

The package would also expand federal privacy and security protections for health IT, such as requiring that an individual be notified if there is an unauthorized disclosure or use of their health information and requiring a patient’s permission to use their personal records for marketing purposes. Details had not emerged by presstime about whether complaints by the privacy community had been addressed. Some watchdogs pressed conferees to take specific steps to close what they argued were marketing loopholes left open in the House and Senate versions as well as make changes to breach notification language. Several sources said they believed a House provision mandating healthcare operations rules from HHS had been dropped entirely. Providers complained the regulations could have required either prior patient consent or the use of de-identified data before information could be exchanged.

President Bush delivered his farewell address Jan 15, 2009. Regardless of one’s party affiliation and political likes and dislikes, a Presidential farewell provides an interesting perspective into the legacy by which a President hopes to be remembered. And this is why I found President Bush’s address so shocking. He begins by acknowledging the truly astonishing nature of the transition:

Five days from now, the world will witness the vitality of American democracy. In a tradition dating back to our founding, the presidency will pass to a successor chosen by you, the American people. Standing on the steps of the Capitol will be a man whose history reflects the enduring promise of our land. This is a moment of hope and pride for our whole nation. And I join all Americans in offering best wishes to President-elect Obama, his wife Michelle, and their two beautiful girls.

Then, he narrows in to the single event that shaped both his speech and his entire presidency:

This evening, my thoughts return to the first night I addressed you from this house — September the 11th, 2001.

Some insight into the administration’s view of US intervention in Afghanistan and Iraq:

Afghanistan has gone from a nation where the Taliban harbored al-Qaida and stoned women in the streets to a young democracy that is fighting terror and encouraging girls to go to school. Iraq has gone from a brutal dictatorship and a sworn enemy of America to an Arab democracy at the heart of the Middle East and a friend of the United States.

Bush contributes 7 years with no terrorist attacks to the creation of the Department of Homeland Security, transformation of the military and intelligence community, and taking “the fight to terrorists and those who support them”:

There is legitimate debate about many of these decisions. But there can be little debate about the results. America has gone more than seven years without another terrorist attack on our soil.

Now, a return to the ideological struggle between good and evil:

The battles waged by our troops are part of a broader struggle between two dramatically different systems. Under one, a small band of fanatics demands total obedience to an oppressive ideology, condemns women to subservience and marks unbelievers for murder. The other system is based on the conviction that freedom is the universal gift of Almighty God, and that liberty and justice light the path to peace.

I’ve often spoken to you about good and evil, and this has made some uncomfortable. But good and evil are present in this world, and between the two of them there can be no compromise. Murdering the innocent to advance an ideology is wrong every time, everywhere. Freeing people from oppression and despair is eternally right. This nation must continue to speak out for justice and truth. We must always be willing to act in their defense — and to advance the cause of peace.

9/11 laid such a heavy burden on this administration that Bush only gives a single paragraph to the other major events of his administration: expansion of Medicare prescription drug benefits, No Child Left Behind (which he doesn’t mention by name), lower taxes, promotion of faith-based programs, and providing assistance to persons living with HIV/AIDS.

Let’s spend a minute on that last one. The President’s Emergency Plan for AIDS Relief (PEPFAR) is largely considered to be the most successful international aid program the US has enacted and recieves strong bipartisan support. PEPFAR provided $50 billion over 5 years to fund anti-retrovirals and contraceptive distribution networks, as well as educational programs (usually abstinence based, although this is changing). PEPFAR has had a slew of problems, but is still one of the largest sources of funding for AIDS relief. Yet, President Bush hardly even mentions it.

But more than anything, I am struck by the divisiveness of his language. President Bush entered office vowing to be a “uniter not a divider”, yet he left with extremely low approval ratings and negative perceptions of the US worldwide. Drawing sharp lines between black and white, good and evil, may be useful to him in his personal life, but divisions such as these can have harmful and polarizing effects in politics. Unity is not achieved by publicly labeling outsiders. If a group identifies themselves by their opposition to you, calling them evil strengthens their identity and opens you up to scrutiny (consider Bush and the torture at Guantanamo).

While discussing this issue with a friend of mine, he said something quite insightful: “Great men in history have created divisiveness and offense without exception. They simply know that their ultimate goals are more important than public acceptance…Great men may create terrible controversy, but at least they have the appropriate methodology and results to back it up.” Therefore, division isn’t the problem, it creating division without support, without evidence, without proper methodology.

Politics is labeled the art of compromise for a reason. Political philosopher Jean Bethke Elshtain states: “But compromise is not a mediocre way to do politics; it is an adventure, the only way to do democratic politics.” Certainly, this argument is a simplification, but I look forward to the departure of divisive ideology from the White House.

If there is anyone out there who still doubts that America is a place where all things are possible, who still wonders if the dream of our founders is alive in our time, who still questions the power of our democracy, tonight is your answer.

To all those watching tonight from beyond our shores, from parliaments and palaces, to those who are huddled around radios in the forgotten corners of the world, our stories are singular, but our destiny is shared, and a new dawn of American leadership is at hand.

Tonight, we proved once more that the true strength of our nation comes not from the might of our arms or the scale of our wealth, but from the enduring power of our ideals: democracy, liberty, opportunity and unyielding hope.

This is our time — to put our people back to work and open doors of opportunity for our kids; to restore prosperity and promote the cause of peace; to reclaim the American Dream and reaffirm that fundamental truth that out of many, we are one; that while we breathe, we hope, and where we are met with cynicism, and doubt, and those who tell us that we can’t, we will respond with that timeless creed that sums up the spirit of a people: Yes, we can.

Responses around the world:

“Your victory has demonstrated that no person… should not dare to dream of wanting to change the world for a better place.” -Nelson Mandela in a letter to Obama

“At a time when we must face huge challenges together, your election has raised enormous hope in France, in Europe and beyond.” -French President Nicolas Sarkozy

“Barack Obama ran an inspirational campaign, energising politics with his progressive values and his vision for the future.” -British Prime Minister Brown

“The American people have to change their policies in order to get rid of the quagmire made by President Bush for them.” -Iranian official Gholamali Haddad Adel

“I hope that this new administration in the United States of America, and the fact of the massive show of concern for human beings and lack of interest in race and colour while electing the president, will go a long way in bringing the same values to the rest of world sooner or later.” -Afghan President Hamid Karzai

“Senator Obama will be taking office at a critical juncture. There are many pressing challenges facing the international community, including the global financial crisis and global warming.” -New Zealand Prime Minister Helen Clark

China’s President Hu Jintao called this “a new period of history”.

The Times of London said Obama had revitalized U.S. politics. “The immense turnout in yesterday’s election was testament to the energy, excitement and expectations of a rejuvenated American democracy, as well as the fears of a nation standing at a crossroads of history,” the paper said.

To celebrate this momentous election, Kenya even declared November 5 a national holiday!

Jason Shafrin, author of the Healthcare Economist blog, wrote an excellent one-page summary differentiating Obama’s and McCain’s strategies for healthcare reform: http://healthcare-economist.com/2008/08/18/obama-vs-mccain-health-care-policies/. Obama’s government-led plan focuses on creation of larger risk pools and compulsary health insurance for children and young adults. McCain’s plan is based on individual agency and free market principles.

If health is a right, as decided by the World Health Organization, and only governments can provide citizens with real rights, then the government must be involved in ensuring its population has the capability to access a basic package of health services. The healthcare system is fundamentally different than the marketplace, which means consumers interact with the healthcare system very differently. Some of the differences:

Information Monopoly – Consumers cannot easily make informed decisions about what services should be provided or how much they should pay for them.

Emergencies – Most consumers, especially sick ones, don’t have time or the knowledge to navigate the health care system to find the best deal. Obama said it very succintly: “When your child gets sick, you don’t go shopping for the best bargain.”

Insurance Pools – Insurance plans require large subscriber bases to spread risk and share costs. The private, state-specific insurance plans have not been capable of creating large enough pools to bring costs down.

False Competition – The open marketplace forces companies to compete for customers on prices and quality. In healthcare, companies compete for market shares but not in a way that improves quality. Costs are usually lowered at the expense of quality. Consumers will sacrifice on the comprehensiveness of their insurance plan for lowered premiums without realizing that the uncovered services statistically improve population health.

McCain’s plan would increase the number of insurance subscribers, but would also make the system more dependent on consumers understanding of their health needs and more dependent on market principles that simply don’t apply to health care.

Obama’s plan is initially more costly, but it will result in an even greater increase in insurance subscribers (especially among children and young adults), and moves responsibility for population health away from individuals and into the hands of the only entity that can provide basic rights to a population level: government.